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LGBTQ+ and racialized populations experience systemic forms of social, economic, and political marginalization, which may increase their risk of exposure to pandemic-related stressors leading to psychological distress. Based on the transtheoretical model of stress and coping, we assess the levels of COVID-19 pandemic-related stressors (i.e., loneliness and social isolation, and COVID-19 related stress). Secondly, we examine the associations between pandemic-related stressors and psychological distress measures (i.e., depressive and anxiety symptoms) among participants from racialized, sexual and gender minority populations in the Greater Toronto Area during the pandemic.
Methods:
Sexual and gender minority, predominantly racialized, people ≥18-years were recruited online from March to November 2021 through community-based organization and health center listservs, and LGBTQ+ online media. A 60-minute online survey assessed the impact of COVID-19 pandemic stressors (CSS) on measures of psychological distress (GAD-2, PHQ-2). We used logistic regression to test associations between COVID-19 pandemic-related stressors and psychological distress (i.e., depressive and anxiety symptoms) controlling for age, race/ethnicity, and education.
Results:
Participants (n=202) (mean age: 29.7 [SD=10.3]) identified as African/Caribbean/Black (29.2%), South/East/Southeast Asian (27.6%), White (20.3%). Latinx/Hispanic (8.9%), and Other (13.9%). Half (54.3%) identified as cisgender lesbian/bisexual/women who have sex with women (LBWSW), 26.2% cisgender gay/bisexual/men who have sex with men (GBMSM), and 19.3% transgender/gender nonbinary people. Regarding COVID-19 stressors, most participants (79.2%) reported feeling lonely and socially isolated, with overall moderate to high levels of COVID-19-related stress (Mean = 23.1, SD=8.2; range 9−42). The majority of participants reported experiencing psychological distress: 68.3% reported anxiety symptoms, and 58.4% reported depressive symptoms. Logistic regression results indicated that for a one-unit increase in loneliness/social isolation, the odds of experiencing anxiety increased by 38% (Adjusted Odds Ratio [AOR]=1.38, 95% Confidence Interval [CI]: 1.14, 1.68). A one-unit increase in COVID-19-related stress increased odds of experiencing anxiety by 10% (AOR=1.10, 95% CI: 1.05, 1.15). For depression, a one-unit increase in loneliness/social isolation increased odds of depressive symptoms nearly twofold (AOR=1.76, 95% CI: 1.42, 2.19), and a one-unit increase in COVID-19-related stress increased odds of experiencing depressive symptoms by 7% (AOR=1.07, 95% CI: 1.02, 1.12).
Conclusions and Implications:
Our findings show that the majority of participants, LGBTQ+ and predominantly racialized people, experienced depression and anxiety symptomology amid the COVID-19 pandemic, along with loneliness and social isolation, and COVID-19-related stress. Moreover, exposure to pandemic-related stressors was significantly associated with greater likelihood of psychological distress, as suggested by the transtheoretical model of stress and coping. The association of loneliness and social isolation with depression signals the importance of specifically considering living situations and the impact of lockdowns on LGBTQ+ and racialized communities, and the need for population-specific supports. Outreach to LGBTQ+ communities from trusted and affirming sources to mitigate COVID-related stress also may reduce pervasive anxiety amid the pandemic. Overall, these findings suggest an urgent need to tailor pandemic response planning, protocols, and programs to the contexts and experiences of racialized LGBTQ+ communities in order to support mental wellness amid the ongoing COVID-19 pandemic, and future pandemics and emergency situations.